The way that you think creates the way you feel. If you have great thoughts then no problem, but if your thoughts are a little distorted, then…look out! Wouldn’t it be great if there were an easy way to look at your thoughts…and change them? As it turns out – there is! In today’s conversation we are going to show you how to identify the kinds of thoughts that lead to depression, anxiety, shame, anger, and self-doubt – and talk about the process that you can go through to eliminate those thoughts for good. Our guest is Dr. David Burns, author of the acclaimed bestseller Feeling Good and one of the leading popularizers of Cognitive Behavioral Therapy (CBT). He is also the creator of TEAM therapy, which takes CBT to the next level. Today, David Burns and I are tackling the topic of “cognitive distortions” – the messed-up thinking that can get you stuck in negative emotions. By the end of today’s episode you’ll not only be able to spot the times when your thinking gets distorted, but you’ll know what to do about it so that you can “feel good”.
If you want to listen to our first episode together, where David Burns and I spoke about how to apply his work in relationships (based on his book Feeling Good Together), here is a link to Episode 98: How to Stop Being a Victim – Feeling Good Together – with David Burns
And, as always, I’m looking forward to your thoughts on this episode and what revelations and questions it creates for you.
Join us in the Relationship Alive Community on Facebook to chat about it!
Check out Dr. David Burns’s website
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Amazing intro/outro music graciously provided courtesy of: The Railsplitters – Check them Out
Neil Sattin: Hello and welcome to another episode of Relationship Alive. This is your host Neil Sattin. On today’s show, we’re going to cover ways that your thinking can be distorted. And, by being distorted can impact the way you feel, the way you behave, the way you interact with other people, and basically get in the way of you being an effectively functioning human being.
Neil Sattin: I’m talking about cognitive distortions and they’ve been mentioned a little bit on the show before, but I wanted to take this opportunity to dive deeply into the ways that our thinking can just be messed up. From that messed upness – and no that is not a technical term – comes all sorts of problems.
Neil Sattin: From today’s show, what my hope is for you is that you understand these things well enough so that you can spot them happening in your own thinking and perhaps in the thinking and reasoning of those around you. We’re going to talk about effective strategies for changing the pattern.
Neil Sattin: In order to do that, we have with us today a fortunate return visit from Dr. David Burns who was on the show back in episode 98 where we talked about how to stop being a victim in your relationship. This was an episode that was all based on David’s work in a book called Feeling Good Together.
Neil Sattin: If you’re interested in hearing that, you can go to neilsattin.com/feelinggood. What I wanted to talk about today relates to some of the pioneering work that David did in popularizing cognitive behavioral therapy primarily through his book Feeling Good which has sold millions of copies all over the world and has been prescribed and shown to actually help people with depression simply by reading the book and going through the exercises.
Neil Sattin: I’m very excited to have David with us today, we’re going to talk about cognitive distortions, we’re probably going to touch on TEAM therapy which is his latest evolution that’s attacking some of the problems with cognitive behavioral therapy. And hear about some of the amazing results that that’s getting and get some insight into how that even works.
Neil Sattin: Without any further ado, let us dive right in. David Burns, thank you so much for joining us again here on Relationship Alive.
David Burns: Thanks Neil, I’m absolutely delighted to be on your podcast for two reasons. First, I think you’re a tremendous host. You know your stuff both technically and you know my background, you do your homework, that’s very flattering to me being interviewed, but also you seem to exude a lot of warmth and integrity, just a pleasure to hang out with you a little bit today and your many, many listeners.
Neil Sattin: Thank you. Thank you so much. I appreciate your saying that. This stuff is important to me. I’m hoping that this podcast makes a big difference in the world and the way that we do that is through being able to feature amazing work like what you do. I don’t want to forget to mention that you also have your own podcast, the Feeling Good Podcast that has amazing insight into the work that you’re doing.
Neil Sattin: In fact, you record sessions with people so people can actually hear you working with clients and then explaining how you did what you did and also getting direct feedback from the people that you’re working with. That’s a fascinating show and how many episodes have you put out at this point?
David Burns: I think Fabrice and I are up to roughly 60, in the range of 60. One really neat bit of feedback we’re getting is that a lot of therapists now are requiring their patients to listen to the Feeling Good podcasts. There’s been a lot of research on my book Feeling Good: The New Mood Therapy and studies have shown that if you just hand the book to someone with moderate to severe depression, 60% of them … 65% of them will improve dramatically within four weeks.
David Burns: That’s really, really good news. It’s called bibliotherapy or reading therapy, but now we’re getting this … I’m getting the same kind of feedback from people who are listening to the podcasts and saying that just listening to the Feeling Good Podcast had a dramatic effect on their depression or their obsessive compulsive disorder or whatever is bothering them. I’m hoping that that trend will continue.
Neil Sattin: Yeah, someone’s going to have to study podcastio-therapy.
David Burns: Yeah, right. You may be having the same thing Neil on your relationship broadcast from people with troubled relationships following the information and the techniques you’re providing and perhaps experiencing genuine improvement in their relationships, greater intimacy and love.
Neil Sattin: Absolutely. I’m getting that kind of feedback all the time from listeners and I also hear that therapists, particularly couples therapists are having their clients listen to the show and even sometimes prescribing specific episodes for them to listen to. It feels really good to be able to be an adjunct part of people’s progress and therapy.
David Burns: Congrats. That’s great. That’s a real credit to the quality of what you’re offering.
Neil Sattin: Thank you. Thank you. Well, let’s dive in. Enough kudos although it does feel really good, though I guess that doesn’t surprise me considering you’re the author of Feeling Good. Quick point of clarification. Is it the just handing of the Feeling Good book that has a 60 to 65% improvement rate or did the people actually have to read some of it to get that?
David Burns: All they have to do is touch it. The improvement comes through osmosis and many of those who have read it have gotten worse. They don’t have good data on that in the studies. It’s people coming to a medical center for the treatment of depression and in the original studies, they said that they had to be on a waiting list for four weeks and during the four weeks, read this book.
David Burns: Then they continued to test them every week with various depression tests and half the patients went to some kind of control group who were on a waiting list control for four weeks or they gave them some other book to read like Viktor Frankl’s book Man’s Search for Meaning and in all of the studies, the patients who were given a copy of Feeling Good, two thirds of them had improved so much within four weeks that they didn’t need to have treatment anymore at the medical center.
David Burns: They never got antidepressants or psychotherapy. Then they’ve done follow up, up to two year follow up studies on these patients as well. For the most part, they’ve continued to do well or even improve more and have not had significant relapses. The alternative groups who got Victor Frankl’s book did not show significant improvement or people on waiting list control.
David Burns: They were pretty well done studies sponsored by research from … sponsored by National Institute of Mental Health and other research groups. Forrest Scogin is a clinical psychologist at University of Alabama and he pioneered a lot of these studies, but there have been probably at least a dozen replications of that finding that have been published now with teenagers, with elderly people and with people in between.
Neil Sattin: Yeah, I want to just say, your book despite having been published a little while ago now is eminently readable and I did read it a while ago. In fact, I think it was one of the first “self-help books” that I stumbled across probably around when I was graduating from college. In sitting down and revisiting it in preparation for our conversation today, I was just struck by how personable, for a book that’s about cognitive behavioral therapy which is something that I think just calling it that probably turns a lot of people off.
David Burns: You bet.
Neil Sattin: The truth is that reading it through, it just makes so much sense and I love how you bring humor into the subject and in many ways talk about yourself as an author in some of the quizzes around the kind of thoughts that undermine our self-esteem. Anyway, I definitely recommend it.
Neil Sattin: If you’re not one of the millions of people who have already read it, you should pick it up and if you are, I would suggest picking it up again to just glean again what more is there. We’re going to talk about one of the central topics in the book which is how our thinking affects the way we feel.
Neil Sattin: Maybe we just start there because that was one place where I even in upon revisiting, I got a little confused and in the past, that’s made total sense to me. Yeah of course, I make something mean something and that gives me an emotional response to it which ironically makes me think of Victor Frankl’s work.
Neil Sattin: At the same time, I know that we have feelings that just our bodies kick in with emotional responses in a split second when something happens. That seems to precede thought. How do you parse that apart in a way that makes sense?
David Burns: Well, the basis of cognitive therapy and we’ve moved on to something new called TEAM therapy or TEAM CBT, but I think the basis of cognitive therapy which as far as it goes it’s still pure gold goes back to the Buddha 2,500 years ago and to the Greek philosophers like Epictetus 2,000 years ago that humans are disturbed not by things, but by the views we take of them that you have to interpret an event in a particular way before you can have an emotional reaction to it.
David Burns: This thought is so basic that our thoughts create all of our moods. We create our emotional reality at every moment of every day by the way, we interpret things, but that’s such a basic idea that many people can’t get it or they don’t believe it. I had an example of this at my workshop in the east coast recently – I was in a hotel.
David Burns: I’ve had many afflictions myself in my life. I love to treat people with depression or anxiety because whatever they have I could say, “Oh, I’ve been there myself.” I can show you the way out of the woods, but when I was little, I had the fear of heights and then I got over it completely as a teenager through a high school teacher who had me stand on the top of a tall ladder until my fear disappeared and took about 15 minutes and it was dramatically effective.
David Burns: Suddenly, my anxiety went from 100 to zero and I was free, but it crept back in because I stopped going up on heights not out avoidance, just I had no reason to and then suddenly I realized it had returned. I was on a hotel on one of these glass elevators and I was going up to the 14th floor and I was looking down into the elevator and I had no emotional reaction whatsoever and it was because I was telling myself and this was automatic I guess, but you’re safe.
David Burns: However, if there hadn’t been that glass there and it would have been the same elevator going up and looking out, I would have been paralyzed with fear and terror and it would have been a total body experience that I can feel in my whole body this extreme terror. That’s the first idea that you can’t have an emotional reaction without having some kind of thought or interpretation.
David Burns: You feel the way you think – your thoughts create all of your moods. After Feeling Good came out, I got a letter from a therapist in Philadelphia. He was a student therapist at the Philadelphia Marriage Counsel I believe and he said he had read my book Feeling Good: How Your Thoughts Create All of Your Moods.
David Burns: He said, “Well, that’s a great idea, but how can it be true? If you’re on a railroad track with a train coming and you’re about to get killed, you’re going to feel terrified. You don’t have to put a thought in your mind, it’s just an automatic reaction.” He said, “I don’t believe your claim that only your thoughts can create your moods.”
David Burns: I got that letter and I started thinking, I said, “Gosh, what he’s saying is so obvious, how could I have missed that when I wrote that book?” I felt embarrassed and ashamed. A couple days after I got that letter, I was in a taxi coming home from the airport and at a certain place on River Road, you go over this railroad track.
David Burns: I looked down the railroad track, I saw there was a car driving on the railroad track at about two miles an hour. Bumpety-bumpety-bump. I looked then in the other direction and this is … Freight trains come through here, they never stop, they come at 65 miles an hour. I saw one about a mile and a half in the other direction.
David Burns: I said, “Man, that guy is going to get smashed by the train.” I told the taxi driver, “Stop, I got to try to get that guy off the railroad tracks.” I ran up and knocked on the window and he rolled down the window and there’s this older man there and he said, “Can you please direct me to City Line Avenue?”
David Burns: I said, “City Line Avenue is 10 miles in the other direction, but you’re on the railroad tracks and there’s a train coming. You’ve got to back up. Back up to get to the road.” Because he was beyond the road, where you know how they have a pile of rocks at the railroad tracks, that’s where he was and I said, “Back up, I’m going to get you off the railroad tracks.”
David Burns: He backed up and he kept … When he got to the road, I said, “Now turn, turn your car.” Finally I had them positioned to where just the nose of the car, the front part of the car was over the tracks and I was standing in front of it. Now the train was about maybe 20 seconds from impact and they had their whistle on.
David Burns: I was waving my hands like, “Back up, back up. Just back up five feet and it will save you.” Instead, the guy started creeping forward very slowly.
Neil Sattin: Oh no.
David Burns: The train smashed into him at the side of his car at about 60 miles an hour.
Neil Sattin: Oh my goodness.
David Burns: Actually ripped the car in half. The front compartment was thrown about 30 feet from the tracks. They had their brakes on, the train was skidding to a stop and I ran over again to the driver’s compartment and looked in, it was all smashed windows and I thought I’d see a decapitated corpse, but it hit probably an inch behind his head and it hit so fast it had just cut the car in half and he didn’t seem to be that injured or anything.
David Burns: He looked at me and smiled and said, “Which way exactly did you say now to City Line Avenue?” I said, “You got to be kidding me.” I said, “You were just hit by a train.” He said, “I was not.” He says, “That’s ridiculous.” I said, “Oh yeah, what happened to the windows of your car?”
David Burns: Then he looked and he noticed all the windows were smashed and there was glass all over. Then he says, “Gosh, it looks like somebody broke my windows.” I said, “Look, where’s the back seat? Where’s the back half of your car?” He turned around and he saw the back half of his car was missing.
David Burns: He looked at me and he says, “I think you’re right. Half of my car seems to have disappeared.” He says, “Where is this train?” I said, “Look, it’s right there, it’s 20 feet from here.” Now the conductors were rushing up and the engineers and he looked at me and he says, “This is great.”
David Burns: I said, “Why is that? Why is this great?” He says, “Well, maybe I can sue.” I said, “You’ll be lucky if they don’t sue you. You were driving down the railroad tracks.” I couldn’t understand it and at this point, the police cars came, the ambulance, they put him in an ambulance, I gave my story to the police, he looked just fine and they took him to the Bryn Mawr Hospital.
David Burns: I was just scratching my head and I got in the taxi, it was just a mile from home, the taxi driver took me the rest of the way home. I was saying, “What in the heck happened?” The next day I was jogging around that same corner, of course, there was all this litter from the car or broken pieces of metal and glass all over the place and there was a younger guy maybe 50 years old or something like that going through the rubble.
David Burns: I stopped there and asked him who he was and he says, “My father was almost killed by a train here yesterday and somebody saved his life and I was just checking out the scene.” I said, “Well, that was me actually.” I said, “I didn’t understand it – he was driving down the railroad track and if I hadn’t gotten there, I think he would have been killed.”
David Burns: I said, “Why was he driving down the railroad track?” He says, “Well, my father has had Alzheimer’s disease and he lost his driver’s license 10 years ago, but he forgot and after dinner, he snuck out. He grabbed the keys and snuck out, decided to take the car for a drive.” Here is the same situation, a train about to kill somebody on a railroad track about to smash into you and I had the thought this guy is in danger he could be killed.
David Burns: I was experiencing 100% terror and anxiety and fear, but his thought was different. His thought was, “This is great. I might be able to sue and get a great deal of money.” Therefore he was feeling joy and euphoria. Same situation, different thoughts and radically different emotions.
David Burns: That’s what I mean and that’s what the Buddha meant 2,500 years ago when we say that only your thoughts can create your emotions. It’s not what happens to you, but the way you think about it that creates every positive and negative emotion.
Neil Sattin: Did you ever write back to that person who wrote you? About that train – to tell him what had happened?
David Burns: I don’t remember it because this was way back in 1980 shortly after the book came out. I probably did because in those days, I was so excited to get a fan letter. I never had any idea that the book would become popular, it didn’t hit the best-seller list until eight years after it was published because the publishers wouldn’t support it with any marketing or advertising because they thought no one would ever want to read a book on depression.
David Burns: When I got a letter in the days before email, I would get so excited and I would try to contact the person and sometimes talk to them for an hour or two on the telephone thinking this might be the only fan I’ll ever have. I’m sure I did write back.
Neil Sattin: Speaking of that, this might be a good chance to start talking about the cognitive distortions and like the idea that this might be the only fan that you ever have, what are we talking about in terms of now we’ve established pretty well. The way I think about things is going to determine how I feel.
Neil Sattin: Yet, there are these distorted ways of thinking about the world that really have an enormously negative impact on our ability to function and interact.
David Burns: This is one of the amazing ideas of cognitive therapy that at first I didn’t quite grasp, but the early cognitive therapists like Albert Ellis from New York and then Aaron Beck at University of Pennsylvania who I learned it from were claiming not only do your thoughts create all of your moods, but when you’re upset, when you’re depressed, when you’re anxious, when you feel ashamed or excessively angry or hopeless, not only are those feelings created by your thoughts and not by the circumstances of your life, but those negative thoughts will generally be distorted and illogical so that when you’re depressed, you’re fooling yourself, you’re telling yourself things that simply aren’t true and that depression and anxiety are really the world’s oldest cons.
David Burns: Beck – when I first began learning about cognitive therapy from him when I was a psychiatric resident and postdoctoral fellow, he had about four distortions as I recall and he had big names for them and then I added some to those and I used to talk to my patients about all-or-nothing thinking and overgeneralization and self-blame and the different ones.
David Burns: Once, I was having a session with a patient and he said, “Why don’t you list your 10 distortions and hand it out to patients?” He said, “It would make it so much easier for us.” I thought, “Wow, that is a cool idea.” I ran home that night after work and I made the list of the 10 cognitive distortions and that’s what led to my book Feeling Good.
David Burns: My list of 10 cognitive distortions, it’s probably been reproduced in magazines and by therapists all over the world, I would imagine easily millions of times and probably tens of millions of times, but there are 10 distortions. Number one is all-or-nothing thinking, black or white thinking.
David Burns: It’s where you think about yourself in black or white term, shades of gray don’t exist. If you’re not a total success, you think that you’re a complete failure or you tell yourself you’re defective. I gave a workshop with Dr. Beck at one of the professional conferences like the Association for Behavioral and Cognitive Therapies, cognitive therapy had just come out and Beck is not a very good public speaker.
David Burns: I was a novice also at the time and we had a half day workshop and there were a few hundred therapists there and it was okay, but it wasn’t great and they started challenging us because nobody liked the idea of cognitive therapy initially, it was scorned and looked down on. We got defensive and then afterwards Dr. Beck looked at me and said, “David, you look like you’re feeling down. What’s the problem?”
David Burns: I said, “Well, to tell you the truth Dr. Beck, I thought we were below average in this presentation and I’m feeling upset about that.” He said, “Oh, well you should, if we were below average, you should thank your lucky stars.” I said, “Why should I thank my lucky stars if we were below average?”
David Burns: He said, “Because average is the halfway point. By definition, we have to be below average half the time. We can thank our lucky stars we got the below average one out of the way and we look forward to an above average one the next time we present.” Suddenly, my discouragement disappeared.
David Burns: He was just modeling thinking in shades of gray whereas I had been thinking in black and white terms. All-or-nothing thinking is very common in depression and it’s also the cause of all perfectionism – thinking if you’re not the greatest, second best or average just is not good enough, it’s either the world or nothing, perfection or failure and it creates tremendous problems.
Neil Sattin: Yeah, I could see that also coming up in terms of comparisons like if so and so is already doing this thing, I can’t possibly do that because it’s so and so’s domain. As if one person could own the domain for the entire world in any particular area.
David Burns: Well yeah, that’s another mental trick that we play in ourselves with the distortions I call mental filtering and discounting the positive. You see this all the time when you’re feeling inferior and comparing yourself to other people. Mental filter is where you focus on all of your flaws thinking about all of your errors.
David Burns: You don’t think about what’s good about you or what’s beautiful about you. I did a TV show finally when the book gained popularity in Cincinnati and it was a morning show and they had a live audience and a band and he was interviewing me. It was exciting for me because it was still the first time I had any media exposure.
David Burns: Then after the show, the host said, “Dr. Burns, could I talk to you for a minute?” This often happens to me when I’m on a radio or TV show because the people in the media have tremendous pressures on them and they often also feel that they’re not good enough. I said, “Sure. I’d love to. What’s the issue?”
David Burns: He says, “Well, after every morning show, I get about 350 fan mails, fan letters or calls or whatever.” He said, “They are 99.9% positive, but everyday I’ll get one critical letter. One critical feedback and I dwell on that one constantly and make myself miserable and ignore all the other positive feedback.” That’s called mental filter because you filter out the good stuff and you’ve just focused on your flaws.
David Burns: A lot of the people listening to the show right now do that. Then an even bigger mental error is called discounting the positive – when you say that the good things about you don’t even count. You may have done this to yourself when someone gives you a compliment, you might tell yourself, “Oh, they’re just saying that to be nice to me. They don’t really mean it.” You discount that positive experience.
David Burns: I had a colleague who got upset when he recently won the Nobel prize, one of my college roommates, and the reason he got upset is he said they haven’t recognized my best work yet. So those are three of the 10 distortions.
Neil Sattin: Yes. One of my favorites I think comes next on your list, at least the list I’m looking at after discounting the positive which is the ways that we jump to conclusions.
David Burns: Right. There’s two common patterns here, jumping to conclusions that aren’t warranted by the facts and mind-reading and fortune-telling are two of the commonest ones. Now, fortune-telling is when you make a prediction about the future, an arbitrary prediction about the future and all anxiety results from fortune-telling, telling yourself that something terrible is about to happen – like when I get on that plane, I just know it will run into turbulence and crash. You feel panic and anxiety.
David Burns: Depressed people do fortune-telling as well. Hopelessness results from predicting that things will never change, my problems will never get solved, I’m going to be miserable forever. Almost every depressed patient thinks that way and that’s actually why many people with depression commit suicide because they have the illogical belief that their mood will never improve, that they’re the one untreatable person.
David Burns: Mind-reading is the other common form of jumping to conclusions and this is real common in social anxiety, but Neil, I’m sure you see it in a lot of people with relationship problems.
Neil Sattin: Absolutely.
David Burns: But mind-reading is where you assume you know how other people are thinking and feeling without any evidence, without any data. I used to struggle with intense social anxiety among my many other fears and phobias that I’ve had and overcome over the years, but the anxious person – say you’re at a social gathering and you think, “Oh, these people won’t be interested in what I have to say and they never feel anxious. I’m the only one who feels insecure.”
David Burns: Then you also may have the thought, “Oh, they can see how anxious I am and they’re going to be real turned off by me.” Then what happens is that when you start talking to someone, you get really busy worrying about how they’re not going to be interested in you. You try to think of something clever or interesting to say while they’re talking.
David Burns: Then when they’re done, instead of repeating what they said and expressing an interest in what they said, you make the little speech you had prepared. That turns the other person off because I think, “Wow, David doesn’t seem interested in me. I was just telling him about my son, he was just accepted to Harvard and now he’s talking about something else.”
David Burns: That person pretty quickly loses interest in you and says, “Oh, I have to talk to so and so on the other side of the room.” Then you, the shy person get rejected again which is what you thought was going to happen. Although these are distortions, you’re thinking in an unrealistic way, they sometimes feel like self-fulfilling prophecies so you don’t realize that you’re fooling yourself.
Neil Sattin: Right, because when you’re in it, then you seem to be getting plenty of evidence that it’s true.
David Burns: Yes, and another form of evidence comes to another distortion. One name I made up called emotional reasoning where you reason from your feelings. You see this in angry interactions, you see that in anxiety and in depression. The depressed patient is giving themselves all these messages like I’m a loser, I’m no good and beating up on yourself and then you feel ashamed and guilty and worthless and inferior and inadequate.
David Burns: Then you say, “Well, I feel like a loser, I must really be one.” Reasoning from your emotions, thinking your emotions somehow reflect reality. That thought by the way is one we skipped over – overgeneralization. That’s number two on the list actually, right after all-or-nothing thinking.
David Burns: Overgeneralization, this is a Buddhist thing, really overgeneralization. It’s where you generalize to yourself from some specific event. For example, I have a free training for Bay Area psychotherapists every Tuesday evening at Stanford and you don’t have to be a Stanford student to come, I give unlimited free psychotherapy training to therapists who can come to my Tuesday group and any of the listeners or therapists near in the Bay Area on a Tuesday email me and you’re welcome to attend my Tuesday training group.
David Burns: Then I also have free hikes every Sunday morning and we go out hiking for maybe three and a half hours on the trails around my home and I treat people for free on the hikes. We do training and one of the women on the Sunday hike, I’ll keep it vague to protect her identity, but she just had a problem with her boyfriend and they broke up and then she was telling herself, “I’m inadequate … I’m unlovable” kind of thing.
David Burns: “This was my fault and I must have been doing something wrong.” You see, when you think like that and most of us do when we’re upset, she’s generalizing from this event, that it didn’t work out with her boyfriend to then this global idea that “I’m inadequate. There’s something wrong with me” – as if you had a self that wasn’t good enough.
David Burns: Then people also say, “I’ll be alone forever. I’m unlovable. This is always happening to me.” That’s all over generalization where you generalize from a negative event and you see it as a never-ending pattern of defeat. You also see it as evidence that you’re somehow defective or not good enough than when you’re thinking these things, they seem so true – just as believable as the fact that there’s skin on your hand.
David Burns: You don’t realize that you’re fooling yourself, the pain that you feel is just incredible. I know that of the many people listening to this show right now, I’m sure you can identify this with this that you’ve had thoughts like that and you know how real and painful these feelings are.
David Burns: It’s one of the worst forms of human suffering, but the good news is and we haven’t gone around to that, but not only are there fantastic techniques, cognitive therapy techniques that we’ve been talking about from my book feeling good described in there or my feeling good handbook so that you can overcome these distorted thoughts and get back to joy and self-esteem quickly, but also my group at Stanford over the 10 years, the past 10 years, we’ve created even more powerful techniques and to help bring about really high speed recovery for people struggling with depression and anxiety.
David Burns: The new techniques are way more powerful than the original cognitive therapy although those methods are still fabulous, but maybe we’ll have time to talk about some of these.
David Burns: But there’s more distortions to cover.
Neil Sattin: Yeah. Maybe what we could do because I’d love to balance this out and I want to ensure that we cover the other distortions. We have maybe four more. At the same time, maybe let’s break from the distortions just to change things up a bit and start entertaining that question of, “Alright, yeah. I relate to some or all that we’ve even listed so far.”
Neil Sattin: What are some of the initial steps that someone could talk because where I tend to go with this is like, “Well, these belief patterns like you talked about, “I’m unlovable” as one, those seem to emerge from a place that’s immutable. It’s something that’s really deep in someone’s psyche and yet, you’re suggesting that there’s ways to transform that that are really quick and direct and give someone a felt experience of the truth that’s not that thing.
David Burns: Yeah, that’s right. You can group the techniques into cognitive techniques to crush these distorted thoughts and motivational techniques to get rid of your … To bring your resistance to change to conscious awareness and melt away the resistance. The patients become incredibly motivated to crush their thoughts.
David Burns: An example of the way the cognitive techniques work, what is crucial and this is one of the first things when we first created cognitive therapy in the mid 1970s was to write the negative thoughts on a piece of paper. It’s a very humble thing to do, but it can be dramatically effective because then you can look at the list of 10 distortions and immediately, pinpoint the distortions and that makes it much easier to talk back to these disruptive thoughts and poke holes in them.
David Burns: I’ll give you an example of my own personal life because I’ve used these techniques myself and if they hadn’t worked for me, I never would have become a cognitive therapist and now a TEAM CBT therapist, but when I was a postdoctoral fellow, I used to go to Dr. Beck’s weekly seminars and I would present all my most difficult cases and get tips from him on how to treat these people with what was then the rapidly emerging brand new cognitive therapy and it was an exciting time, but one day, I talked to him about a patient that wasn’t paying the bill, that I’ve had a bad session with this patient and asked him for some guidance.
David Burns: He actually was pretty critical of the way I had dealt with this patient. I became awfully upset, I got depressed and anxious and I was riding home on the train and my head was filled with negative thoughts and negative feelings. Then when I got home, I told myself, “Well David, you probably better run, go on a long six mile run and get your brain endorphins up so get over your depression” because those were the days when everyone was believing the phony baloney that somehow exercise boosts brain endorphins and will reduce depression.
David Burns: I went out on this long run and the longer I ran, the more believable my negative thoughts became. I said, “David, what are you telling yourself?” I said, “Oh, I’m a worthless human being. I have no therapeutic skills, I’m going to be banned from the state of Pennsylvania and they’ll take away my medical license, I have no future in psychiatry. I’m a worthless human being, I’m a bad person.” Stuff like that.
David Burns: It seemed overwhelmingly true. I said, “Are there some distortions in your thoughts David? Look for the distortions like what you tell your patients.” I said, “No, there are no distortions in my thoughts. This is just real.” I was telling myself it’s so weird to hear, you’re something like 30 years old or however old I was, 31, it took you all of this time in your life to realize what a horrible loser you are.
David Burns: It’s as if I had seen the truth for the first time and it was devastating. Then when I got home, I said, “David, why don’t you write your thoughts on a piece of paper? That’s what you make all of your patients do.” I said, “Oh no, no, my thoughts are real, that won’t do any good.” Then I told myself, “But isn’t that the same way you’re whining just like your patients whine and resist? And you force them to write their thoughts down on a piece of paper. You tell them they have to do that. Why don’t you try that David?”
David Burns: I said, “No, no, it wouldn’t do any good. I really am a worthless human being. This is true.” Then I said, “No David, you’re still resisting. Take out a piece of paper and do what you tell your patients to do.” I said, “Oh okay, I’ll do it just to prove that it won’t work.” I wrote my thoughts down. Number one, I’m a worthless human being, number two, I have no therapy skill.
David Burns: Number three, I screwed up with this patient. Number four, they’ll take away my medical license, stuff like that. I wrote down four or five thoughts. Then I said, “Now, are there any distortions?” I looked at my own list of 10 distortions. I said, “Wow, those thoughts are pretty distorted. It’s all-or-nothing thinking, black and white thinking like I’m not allowed to make a mistake with a patient. It’s overgeneralization, I’m generalizing from the fact that I screwed up with this patient in a session to, “I am a worthless human being,” it’s fortune-telling, “I have no future in psychiatry.”
David Burns: Jumping to conclusions, self-blame, hidden “should” statements, that’s another distortion. I shouldn’t have screwed up, I should always be perfect. It was emotional reasoning, I feel worthless, I must be worthless. I suddenly saw those distortions and then I said, “Now, can I write a positive thought to challenge these negative thoughts?” That’s the other part of the exercise. First you write the negative thought, then you identify the distortions, then you write a positive thought.
David Burns: The positive thought has to be 100% true. Rationalizations and half truth will never help a human being. I came up with this positive thought. I said, “David, you’re just a beginner. You have the right to make mistakes. In fact, even when you’re 75 years old years from now, you might be a great therapist, but you’ll still make mistakes and learn from them. That’s part of the territory.”
David Burns: “You’re absolutely permitted to do that. Instead of beating up on yourself, why don’t you talk it over with your patient tomorrow and tell him that you made a mistake and see if you can repair that rupture in your relationship with the patient.” All of a sudden, I said, “Is that true?” “Yeah, that thought is 100% true.” How much do I believe this rubbish that I’m a worthless human being and all of that and my belief in those negative thoughts went to zero and my negative feelings just disappeared in a flash entirely. I said, “Wow, this shit is pretty good. This really works.” Hope you don’t have to edit out that word.
Neil Sattin: No, that’s fine. That’s fine.
David Burns: Then the next day I saw the patient, I said, “You know Mark, I’ve been feeling terrible since last session and ashamed because I don’t think I treated you right.” I was putting pressure on you because of the unpaid balance and I didn’t put any emphasis on your suffering and what’s going on with you as a human being I just imagine you felt so hurt and angry with me and discouraged and I’m just overjoyed that you came back today rather than dropping out of therapy so we can talk it over and see if we can deepen our relationship.
David Burns: He just loved that and we had the best session ever, he gave me perfect empathy scores at the end of the session, but that’s just an example from my personal life and I’m sure the people here can relate to that, but I’ve developed probably 50 or 100 techniques for crushing negative thoughts and I’ve made it sound easy, but it isn’t always easy because you might be very, very trapped in your negative thoughts.
David Burns: You might have to try several of the different techniques before you find the one that works for you. I want to be encouraging to the listeners and to therapists who may be listening, but I also don’t want to make it sound like something overly simple or overly simplistic because it’s really a pretty high-powered, sophisticated type of therapy.
David Burns: Fortunately, many people can make it work on their own, but anyway, that’s the half of the treatment breakthroughs and that was called the cognitive revolution and my book Feeling Good really helped usher that in when feeling good came out in 1980, cognitive therapy was virtually unknown and they were just a handful of cognitive therapists in the world.
David Burns: Now, it’s become the most popular form of psychotherapy in the world and the most researched form of psychotherapy in all of the history of psychology and psychiatry.
Neil Sattin: I wonder if we could emphasize because I’m thinking about how we talked about the technique for identifying a negative thought, identifying the cognitive distortion or distortions that are happening and just to talk about the importance of actually going through that exercise and writing it down.
Neil Sattin: Maybe you could just talk for one more minute about why that part is so important. Why is it important to actually write that stuff down versus to do it in your head?
David Burns: I think that the negative, the power of the human mind to be negative is very profound. The negative thoughts are like a snake eating its tail, they go round and round and one leads to the next.
David Burns: In the early days, I used to try to do cognitive therapy without the written exercise and to this day, new therapists still try to do that. They think they’re too fancy that writing things down is too simplistic or something like that and they’re going to be deep and just do verbal, deep stuff with people, but the problem is, the human mind is so clever.
David Burns: Each distortion reinforces another one and each negative thought reinforces another one and you go round and round and round. That’s why doing it verbally or in your head when you’re alone is rarely going to be effective, but when you write the negative thoughts down one at a time and number them with short sentences, that makes it much easier to identify the distortions in them and turn them around.
David Burns: There are three rules of thumb. There’s an art form to writing them down. Everything is more sophisticated than I make it sound in a brief interview. There’s a lot of rules of the game. For example, when you’re writing down negative thoughts, you should never put an emotion or an event.
David Burns: People have a negative thought like Trisha rejected me and I feel terrible. Well, that’s not a negative thought. That’s an event. Trisha rejected me and I use a form called the Daily Mood Log and at the top you put the event and then you circle all of your emotions and put how strong they are between zero and a hundred.
David Burns: These emotions might be feel guilty, ashamed, lonely, depressed, worthless and then the negative thought would be the interpretation of that event like I must be unlovable, I’ll be alone forever. Then those are things that have distortions. A second rule is don’t ever put rhetorical questions in the negative thought column.
David Burns: If you say something like, “Oh, why am I like this? Why am I so anxious in social situations?” Or “What’s wrong with me?” You can’t disprove questions so instead you can substitute the hidden claim behind the question which is generally a hidden should statement like I shouldn’t be like this or I must be defective because I’m so anxious in social situations or some such thing.
David Burns: There are probably one or two other rules of the game and my book When Panic Attacks which is one of my newer books on all the anxiety disorders, Feeling Good is on depression. When Panic Attacks is on all of the different kinds of anxiety. I think the third chapter shows how to fill out the Daily Mood Log and what the rules are to follow to enhance the effectiveness of it so you’ll be more likely to have a successful experience.
Neil Sattin: Great. The idea is that it’s simply by doing this process that the things shift. It’s not like there’s … You go through the process and then maybe you would track your mood afterwards and see, “Wow, I’m actually feeling better than I was before” just by simply doing that?
David Burns: Well, a lot of people can feel better just by doing it, but the research has shown that two thirds of people just by reading Feeling Good, they can improve a lot in depression, but some people need the help of a therapist and it isn’t true that everyone has to do it on your own, sometimes you need another person to get that leverage to pop out of it.
David Burns: Another thing that’s helpful when you’re writing down your negative thoughts is Beck’s theory of cognitive specificity. You see, Buddha said our thoughts create our emotions, but Beck took it to the next level and said different patterns of thoughts create different types of emotions.
David Burns: If you’re feeling guilty, you’re probably telling yourself that you’re a bad person or that you violated your value system. If you’re feeling hopeless, you’re definitely telling yourself that things will never change, something like that. I’ll be miserable forever. If you’re feeling anxious, you’re definitely telling yourself something awful is about to happen.
David Burns: “When I get on that show with Neil, I’ll screw up, my brain will go blank.” That type of thing. When you’re feeling sad, you’re telling yourself… or depressed, that you’ve lost something central to your self-esteem. When you’re feeling angry, you’re telling yourself that someone else is a loser that they’re treating you unfairly, that they shouldn’t be that way.
David Burns: These rules can also help individuals pinpoint your negative thoughts. Once you see what the emotions are, then you know the kind of thoughts to look for. One last thing is sometimes people say, “Oh, I don’t know what my negative thoughts are.” I just say, “We’ll just make some up and write them down and number them.”
David Burns: Then I say, “Are your thoughts like this?” They say, “Oh, that’s exactly what I’m thinking.” Those are a few tips on refining the part with the negative thoughts. But now we have even more powerful techniques that have evolved in my work with my training and development group at Stanford.
Neil Sattin: Yeah, before we talk about those, which I hope we will have time to do – there are a couple of things that jumped out at me. One was as you were describing the distortions that we’ve already talked about, it popped into my head that this is often at the source of most conflict that happens in couples – that either one person is having distorted thinking or one person is protecting themselves from their own distorted thinking.
Neil Sattin: For example, your partner says something and you have this feeling like, “Well, that’s not true. I got to defend myself from that accusation.”
David Burns: That’s right yeah.
Neil Sattin: You jump into this place of conflict that’s all about proving that this negative concept you suddenly are perceiving about yourself isn’t true. When that negative concept in and of itself might be an example of you just having a distortion – like for instance, “my partner is mad at me, that must mean they think I’m a horrible human being.”
David Burns: Yeah, what’s huge what you just said, when we’re in conflict with people, there’s a lot of inner chatter going on in addition to the verbal altercations, the arguing, the escalation, the defensiveness – and some of the distortions will be focused on the other person and some of the distortions will be focused on yourself.
David Burns: You see all of the 10 cognitive distortions in relationship conflict, but they have a little bit of a different function I would say. Now, let’s say you’re angry, Mary is angry at her husband Sam, she’s ticked off and then if you look at her thoughts, they have all 10 distortions.
David Burns: She’ll tell herself things like, she might be thinking, “Oh, he’s a loser. All he cares about is himself. The relationship problems are all his fault, he’ll never change.” That type of thing. You sell all-or-nothing thinking, mind-reading, imagining how he’s thinking, you see blame, you see hidden should statements, he shouldn’t be like that, he shouldn’t feel like that.
David Burns: You see discounting the positive, mental filtering, overgeneralization, magnification, minimization. You see all the same 10 distortions. The only difference is that when you’re depressed and I can show you that your thoughts about yourself are distorted and that’s not true that you’re a loser, you’re going to love me, the therapist, you’re going to appreciate that and you’re going to feel better and you’re going to feel better and recover from your depression.
David Burns: When people are in conflict and we’re having distorted thoughts about the other person, we’re generally not motivated to challenge those distortions because they make us feel good. We feel morally superior to the other person. I don’t generally work with people too much on changing their distortions about others because they don’t want to hear it.
David Burns: If the therapist finds out that this woman, that her thoughts about her husband are causing her to be upset, not her husband’s behavior, and in addition that her thoughts about her husband are all wrong, wrong, wrong, they are all distorted, she’ll just fire the therapist and drop out of therapy and she’ll have two enemies, her loser of a husband and her loser of a therapist.
David Burns: That’s why I developed some of the techniques we talked about in the last podcast we did on relationships. I used slightly different strategies, but you’re right, those distortions are incredibly positive and the other kind of distortion you have when you’re in conflict if someone’s criticizing you, again you may start thinking, “This shows that I’m a loser, I’m no good. I should be better than I am. If you’re criticizing me, that’s a very dangerous and terrible situation.”
David Burns: By attending to those kind of thoughts that make you feel anxious and ashamed and inferior and guilty and inadequate, then you can modify those and then do much better in the way you communicate with the other person because your ego isn’t on the line. An example with me is in my teaching, I always get feedback from every class I do, every student I mentor or supervise from every workshop and I get it right away, I don’t get it six months from now, I get it the very day that I’m teaching.
David Burns: I get all kinds of criticisms on the feedback forms I’ve developed even if I have a tremendous teaching seminar, I’ll get a lot of criticisms especially if they feel safe to criticize the teacher. I find that if I don’t beat myself up with inner dialogue, then I can find the truth in what the student is saying and treat that person with warmth and with respect and with enthusiasm even.
David Burns: Then they suddenly really love the way that I’ve handled their criticism and it leads to a better relationship and that’s true between partners or in families as well. That inner dialogue that’s where we’re targeting ourselves and making ourselves needlessly anxious and defensive and hurt and angry and worthless when we’re in conflict with someone – that can be adjusted and modified to really enhance relationships.
Neil Sattin: The two distortions that we hadn’t really covered yet, you just mentioned them and I thought … We’ve mentioned them all at this point, but some of them like blaming, whether it’s blaming yourself for a situation or blaming others for a situation, that seems a little self-evident.
Neil Sattin: I’m curious if you could talk for a moment about labeling and then also magnification and minimization just because I think those are the two that we listed, but didn’t really cover.
David Burns: Did we mention shoulds?
Neil Sattin: Let’s mention them and I think again, that might be something that’s a little more understandable for people, but yeah, let’s do this.
David Burns: Oh yeah, okay. Yup. Well, labeling is just an extreme form of overgeneralization where you say I am a loser or with someone else, “He is a jerk.” Where you see yourself or another person as this bad glob so to speak. Instead of focusing on specific behaviors, you’re focusing on the self. When you think of yourself as a loser or a hopeless case, it creates tremendous pain.
David Burns: When you label someone else as a jerk or a loser, it creates rage and then you’ll often treat them in a hostile way and then they treat you in a hostile way and you say, “Oh, I know he was a loser.” You don’t realize you’re involved in a self-fulfilling prophecy and you’re creating the other person’s, you’re contributing to or creating the other person’s hostile behavior.
David Burns: Magnification or minimization is pretty self-evident – where you’re blowing things out of proportion – like procrastinators do that. You think about, “All you have to do, all the filing that you’re behind on.” It feels like you have to climb Mount Everest and you got overwhelmed and then minimization, you’re telling yoruself, “Oh, just working on that for five or 10 minutes would be a drop in the bucket. It wouldn’t make a difference.” You don’t get started on the project.
David Burns: We’ve done those two. The should statement say I think is very subtle and not obvious to people at all that we beat up on ourselves the shoulds and shouldn’ts and oughts and musts and we’re saying, “I shouldn’t have screwed up, I shouldn’t have made that mistake. I should be better than I am.”
David Burns: That creates a tremendous amount of suffering and shoulds go back – if you look at the origin in the English dictionary, maybe we did this in our last podcast, I don’t recall that if you have one of these thick dictionaries, you’ll find the origin of the word should is the Anglo’s accent word scolde, S-C-O-L-D-E where you’re scolding yourself or another person, where you’re saying to your partner, “You shouldn’t feel that way.” Or, “You shouldn’t believe that.”
David Burns: We see that politically, two people are always blaming someone they’re not in agreement with and throwing should statements at them. Albert Ellis has called that the “shouldy” approach to life which is a cheap joke I guess, but it contains a lot of truth. The feminist psychiatrist Karen Horney who actually I think was born in 1890s did beautiful work on shoulds – when my mother, when we moved to Phoenix from Denver, I think my mother got depressed and she read a book by Karen Horney on the Tyranny of the Shoulds, how we give ourselves all these should statements and make us feel like we’re not good enough and we’re not measuring up to our own expectations and create so much suffering.
David Burns: I think that book was very helpful to her and then Albert Ellis in New York saw that, he argued and I think rightly so that most human suffering is the result of the shoulds that we impose on ourselves or the should statements that we impose on others.
Neil Sattin: Well, if that’s true, then maybe that should be what we take a moment to attack and I’m wondering if you have a powerful crushing technique that works with shoulds whether it’s and maybe it would be a little bit different, the ones that we wield against ourselves versus so and so should know or should have done this differently.
David Burns: Right. Well, a lot of the overcoming has to do with the mystical, spiritual concept of acceptance, accepting yourself as a flawed human being is really the source of enlightenment, but we fight against acceptance because we think it’s like giving in and settling for second best. We continue to beat up on ourselves thinking if we hit ourselves with enough should statements, we’ll somehow achieve perfection or greatness or some such thing.
David Burns: One thing that I learned from Ellis that has been really helpful to my patients is that there’s only three correct uses of the word should in the English language. There’s the moral shoulds like the 10 commandments, thou shalt not commit adultery, though shalt not steal or thou shalt not kill.
David Burns: There’s the laws of the universe should where if I drop a pen right now, it should fall to the earth because of the force of gravity and then there’s the legal should. You should not drive down the highway at 90 miles an hour because that’s against the law and you’ll get a ticket. Now, I had a colleague who came on one of the hikes who has a developmentally challenged child, say a son just to disguise things a little bit and she’s from a very high achieving family, Silicon Valley family just to say the least.
David Burns: She and her husband are giants, geniuses and then she went to the grammar school for the parent’s day and they had all the kids and they have their daughter in some very expensive private school. The kid’s pictures were up on the wall and then she saw her son’s picture and it was just very primitive compared with the other children who are real high-powered children from high powered families.
David Burns: Her son struggles severely and then she saw that and she felt the feeling of shame. Then she told herself, “I should not feel ashamed of my son.” That’s hitting herself with a should statement which it’s like she doesn’t have permission to have this emotion and that’s what we do to ourselves.
David Burns: That’s not a legal should, it’s not illegal to feel ashamed of yourself or your son. She then was also of course feeling ashamed of herself. It’s not immoral and it doesn’t violate the laws of the universe. A simple technique that Ellis suggested and it’s so simple it goes in one ear and out the other instead of saying, “I shouldn’t, you can just say it would be preferabe if or I would prefer it if or it would be better if.”
David Burns: You could say it it would be better, it would be preferable if I didn’t feel ashamed of my son, but that’s the human feeling and probably other parents feel upset with their children, they feel ashamed sometimes of their kids or angry with their kids. It’s giving yourself permission to be human and that’s called the acceptance paradox.
David Burns: The paradox is sometimes when you accept your broken nature, accept your flaws and shortcomings, you transcend them. I’ve often written that acceptance is the greatest change a human being can make, but it’s elusive and Buddha tried to teach this 2,500 years ago when I saw on TV and I don’t know if was just a goofy program, but it was on PBS that he had over 100,000 followers in his lifetime and only three achieved enlightenment.
David Burns: I think it was frustrating to him and disappointing, but I can see it clearly because what he was teaching was so simple and basic and yet it’s hard for us to grasp it and that’s why I love doing therapy because we’ve got powerful new techniques now where I can bring my patients to enlightenment often in a single therapy session if I have more than an hour.
David Burns: If I have a two hour session, I can usually complete treatment in about a session and see the patient going from all the self-criticism and self-hatred and misery to actually joy and euphoria. It’s one of the greatest experiences a human being can have because when my patient has a transforming experience, then it transforms me at the same time.
Neil Sattin: Can you give us a taste of what some of the more powerful new techniques are and how they might work in these circumstances?
David Burns: Yeah, they’re pretty anti-intuitive and it took me many years of clinical practice before I figured it out and before it dawned on me. I would say very few therapists know how to do this and it’s absolutely against the grain of the way therapists have been trained and the general public have been trained to think about depression and anxiety as brain disorders.
David Burns: The DSM calls them mental disorders. We’ve gone in the opposite direction and I’ll just make it real quick because we’re getting long on people’s time here I’m afraid, but when I am working with a person, like last night at my Tuesday group, we were working with a therapist and someone who’s in training to become a therapist and she was being very self-critical and telling herself she wasn’t smart enough and just beating up on herself and saying that she was defective and she should be better at this and she should this, she shouldn’t that.
David Burns: She was feeling like 90% depressed and 80% ashamed and intensely anxious. One thing I do before I … She had all these negative thoughts, “I’m defective” and I don’t have the list in my hand, but she had about 17 very self-critical thoughts. After I empathized and my co-therapist was Jill Levitt, a clinical psychologist who I teach with at Stanford and Jill is just a gem, she’s fantastically brilliant and kind and compassionate and humble.
David Burns: After we empathized with this individual and I’ll just keep it vague because most therapists feel exactly the same way so I won’t give any identifying details, but we asked this young woman, “Would you like some help today?” With her depression and anxiety. If we had a magic button on the table and she pressed it, all our negative thoughts and feelings would instantly disappear.
David Burns: Would she press the magic button? She said, “Oh yeah, that would be wonderful.” I guess she’s felt this way on and off throughout her life since she was a little girl that she is somehow not good enough. Then we said, “Well, we have no magic button, but we have amazing techniques.” But before we use these techniques, maybe we should ask, “What are your negative thoughts and feelings show about you that’s beautiful and awesome?”
David Burns: Also, “what are some benefits to you in having all of these negative thoughts and feelings?” She was very puzzled by that at first as most therapists are like, “How could there be benefits from having depression? We learn that’s some kind of mental disorder or major depressive disorder, dysthymic disorder, all these fancy names pretending that these are mental illnesses of some kind.
David Burns: But then she got in the flow, we primed the pump a little bit and she was able to come up with a list of 20 overwhelming benefits to her and beautiful things about her that were revealed by her negative thoughts and feelings. For example, when she says, “I’m defective.” She will say, “Well, it shows that I’m honest and accountable. Because I do have many flaws.”
David Burns: Then a second benefit was “it shows that I have high standards.” I was able to say, “Do you have high standards?” She said, “Absolutely.” I said, “Have your high standards motivated you to work hard and accomplish a lot?” She says, “Oh yeah, absolutely.” That was the third benefit. Then the fourth benefit is her self-criticism showed that she’s a humble person. That was the fourth benefit, the fourth beautiful thing it showed about her.
David Burns: Then we pointed out that humility is the same as spirituality. Her self-criticism shows that she’s a humble and spiritual person and then her sadness showed her passion for what she hopes to achieve which is a role as a therapist and a good therapist and her self-doubt keeps her on her toes and motivates her to work really hard.
David Burns: Her suffering shows enhances her compassion for others and her shame shows that she has a good value system, a good moral compass and on and on and on, then we came up with a list of when we got to 20 benefits of her negative thoughts and feelings, then we simply said to her, “Well, maybe we don’t want to press that magic button because when your negative thoughts and feelings disappears, then these other good things will disappear as well. Why in the world would you want to do that?”
David Burns: We have become the role of her subconscious mind and the therapist is paradoxically arguing for the status quo and not arguing for change. The therapist’s attempt to help or change the patient is actually the cause of nearly all therapeutic failure both in the treatment of depression and anxiety as well as in your specialty area which is relationship conflicts.
David Burns: Then we did a little thing to help her resolve this conflict called the magic dial which is instead of pressing a magic button and making them all disappear, maybe it’s appropriate to have some negative feelings fro time to time. How depressed would you want to feel when you walk out of the room tonight at the end of the evening?
David Burns: Maybe you don’t need 90% to have the benefits of the sadness and the depression. What would be a good level? What would you like it to be? She said, “Well, maybe 20% would be enough.” Then, “Yeah, okay.” We make that her goal, we’ll reduce it to 20. Then if she want to reduce her anxiety to 15 and reduce the shame to five and reduce the anger to 15 and these different goals we set for her.
David Burns: Then I said, “Okay, we’ll reduce them to just that level, but no higher. Now, you have to be careful because the techniques are so powerful that we’re going to use now that your depression may go below 20. It may get all the way to zero or five, but don’t worry, if we overshoot before the end of the evening, I help you work your depression back up to 20.”
David Burns: Then she started laughing, but at this point, we’ve made a deal with her subconscious mind and then she’s in control. We’re not imposing our values on her. She’s saying, “I’m willing to go to this level.” Then at that point, we’re generally five or 10 minutes away from total enlightenment which is what happened last night.
David Burns: She started just crushing her negative thoughts and finding the distortions in them because her subconscious mind is now giving her permission to fight these distorted thoughts. By the end of the evening, we worked with her for about two hours including teaching about 30 therapists who are launching, teaching along the way and pretty much everything went to zero.
David Burns: At the moment of that, she suddenly received her enlightenment, she started sobbing because she was so euphoric and ecstatic. At the end of the evening, it was not just feeling less depressed and anxious because all the feelings pretty much went to zero, but she went into a transcendent state of what I would call spiritual enlightenment.
David Burns: It’s just mind-blowing and most therapists in the general public, they don’t even know that these new techniques exist and that these fantastic rapid changes are possible, but that’s what I see. Almost every time I treat somebody now and it’s mind-boggling and that’s why I’m so grateful to have had the chance to be on your show today to try to get the word out more.
David Burns: I’m writing a new book about it as well. The tentative title will be Feeling Great. It will have all of these new positive reframing and resistance busting techniques along with the powerful cognitive techniques.
Neil Sattin: Just to step up a little bit, it sounds like the technique that you described is all about laying the ground work so that when you go back to doing the cognitive work, you have way less inner resistance to that change actually happening.
David Burns: Yeah. Usually there’s none and all patients have within them and everyone listening to the show right now, this powerful healing voice, but we keep it suppressed because of the resistance thinking we don’t want to give up our perfectionism for example. We think that if we keep beating up on ourselves, that’s somehow honorable or good or motivating and that’s why in all of the psychotherapy outcome studies for depression, at least 50% of the patients don’t improve much at all and it’s because all these schools of psychotherapy are busy throwing help at patients without stopping to think, “What are some reasons this person might want to resist change?”
David Burns: The kinds of reasons we have come up with for resistance are all flattering to the patients. We make the patients proud of their symptoms, proud of their resistance and paradoxically when we do that, suddenly they want to change and then recovery is generally just a matter of minutes away like eight minutes or 12 minutes or something in that range.
Neil Sattin: Wow. While we wait for your new book to come out, what are the best ways for people to get more information about these techniques if they’re not in the Bay Area?
David Burns: On my website, http://www.feelinggood.com, feeling good is one word with two G’s in the middle. There’s tons of free resources for therapists and general public alike. There’s a Feeling Good blog, the Feeling Good podcasts, there’s all kinds of stuff. I probably have at least 500 or maybe a thousand or more pages of free resources there for folks and I would say that’s a good step in the right direction or to pick up the feeling good handbook or the feeling good book because those tools are still incredibly powerful and helpful to millions of people in the United States and around the world as well.
David Burns: Feeling Good is now in over, well over 30 languages. It sold more than five million in the US and I have no idea how many more worldwide. Those techniques are still as good as gold and really helpful for individuals.
Neil Sattin: Wow. Well, we will have links to your site and your books available on the show notes for this episode which you can pick up by visiting neilsattin.com/feelinggood2 or you can always text the word passion to the number 33444 and follow the instructions to get the transcript and action guide for this episode. David, I’m wondering if we have time for one more quick question.
David Burns: Absolutely.
Neil Sattin: This is of course a relationship show. A lot of what we’ve talked about is ways of turning the work inward, noticing the cognitive distortions that are coming up within you and how you can attack them powerfully in order to neutralize their effect and actually be more present, more in the moment and more able to have feelings that are actually based on reality and not just on something that you’re making up.
Neil Sattin: However, when I think about hanging out with Chloe tonight, my wife, who’s amazing, I wonder about what should I do, not that this would ever happen, but what if I notice her saying something or let’s just flip this around. What if Chloe listens to this podcast and then she notices that I am using some cognitive distortion, some distorted thinking is coming out of me.
Neil Sattin: What’s the best way for Chloe as my partner to avoid the pitfalls of maybe calling me out on it, but still to turn it into a generative conversation when she recognizes exactly what’s going on? “Oh Neil, he’s just trapped in blame again.” Or not that I would ever do that, but a should statement, whatever it is.
David Burns: Well, I may not have the answer you’re looking for here, but I do have a definite answer to that. I write books for people to help themselves, not to try to help other people or to impose these ideas on someone else because if you go around saying to someone, “Oh, you’re having this distorted thought or that distorted thought.”
David Burns: It would just irritate the heck out of them. If you have a family member or friend who’s depressed, you could give him a copy of Feeling Good or suggest they pick up a copy of Feeling Good and it will probably be very helpful to them, but when you see another person involved in distorted thinking, I think that the thing that you can do in this too is hard to learn and probably would need another podcast would be to empathize and to listen and to provide emotional support without trying to help or fix them or change the distortions and their thoughts because I can tell you that it’s not going to be effective to throw help or advice at someone who’s angry at you or who’s depressed and angry with themselves.
David Burns: Empathy can have a certain healing power and I think is about as far as we need to go as general citizens, as partners, as family members. I think empathy itself requires a lot of training and learning to do it skillfully and it’s a gift that the world needs where we’re not seeing a lot of empathy and support for one another in the world.
David Burns: We’re seeing a lot of attack and criticism and trying to change other people, trying to punish other people and those strategies in my opinion are usually doomed to failure or as empathy and warmth and compassion has always been a gift through the ages.
Neil Sattin: I would love to have you back on the show to chat about empathy. In the meantime, I will make sure that if I hear any cognitive distortions, I don’t go offering a magic button too.
David Burns: Yeah, exactly. Exactly. Thank you so much Neil and maybe another six months down the road or something we’ll do Feeling Good part three, but it’s always an honor for me to work with you and I have a tremendous respect for you because of the quality of what you bring to the interview and to the dialogue which I just think is tremendous.
Neil Sattin: Thank you so much David and the feeling is mutual.
Check out Dr. David Burns’s website
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